Florence Nightingale’s Fever

Diagnose this driven nurse at your own risk.

Florence Nightingale.

Last summer, the Florence Nightingale Museum in London announced a holiday program for children. It ran like this: “Daily-changing drop-in activities include crafting a pattern lantern like the one made famous by the Lady with the Lamp, designing a lace bonnet like Flo’s, drawing a family portrait book based on images of the Nightingale family on display in the museum, and working with an artist to create a watercolour picture of a germ.” Meanwhile, across London the Serpentine Gallery was hosting a retrospective of Richard Prince’s avant-gardist art, including recent work that repaints the covers of pulp novels about nurses. In stiff white gowns and tidy caps, with masks across their mouths and beneath their staring eyes, Prince’s nurses (appearing under such titles as “Student Nurse,” “Mission Nurse,” “Runaway Nurse,” and “Dude Ranch Nurse”) are semi-lurid, often bloodied, and, above all remote, unsettled, opaque. Who are these nurses? What are they after?

Between sweet sentimentality and strange opacity is where Florence Nightingale lives today. Now, as back then, her reputation is tended by devoted admirers, who esteem her as the founder of modern nursing, a paragon of public service, the exemplary heroine. But already in its mid-Victorian origins there was a counter-mythology that grew and flourished in the 20th century. It never got as edgy as Prince’s nurses, but it was full of subversive implication about her sexuality, her hypochondria, her will to power. What did Nightingale want? And what did the culture want with her? The subtitle of Mark Bostridge’s new biography is The Making of an Icon, and his book splendidly charts the astonishing arc of her celebrity. Even more intently, though, it follows Nightingale’s passionate, obstinate self-making. The biographic record gives us no reason to believe she set out to create a legend for herself or even to achieve reputation on the small scale. Accidents of history placed her in the hanging cage of celebrity.

The shelves are cluttered with biographies of Nightingale; Bostridge’s won’t be the last, but for now it’s surely the best. He shows great care with the overwhelming mass of material (all the published and unpublished writing, all the density of such a long life), sorting subtle personal relationships tactfully, and never pressing such a large and angular life into chewable tablets of hypothesis. He knows that every surface of Nightingale has been written up and covered over, but he efficiently steers free from both the hagiographers and the cynics who preceded him. Without straining for novelty or original synthesis, Bostridge aims for (and achieves) accuracy, coherence, balance, readability, and accumulating force. But what makes for underground excitement in the book is that the subject, F.N., lives out the spectacle and excess of her life while the author maintains the discipline of his equanimity. Her life pulls toward grand gestures and eccentricity; his account stands for fairness and sympathy. We should all be so lucky with those who think about us.

Nightingale has been marked and branded as one of the Victorians, furiously earnest and exhaustingly brisk. To open her Notes on Nursing (1860) is to snap immediately to attention and begin washing your hands. “Windows are made to open; doors are made to shut”; “[a] dark house is always an unhealthy house, always an ill-aired house, always a dirty house.” She worked to save wounded soldiers in the Crimean War (1854-1856), and then the ambitions grew: to reform the management of health throughout the army, to train professional nurses of the future and domestic nurses in the present, to transform the architecture of hospitals, to improve the health of those bringing empire to the subcontinent and, finally, to all of India. She worked herself into a frenzy, then into exhaustion, and then back to frenzy. (She called her life “a fever.”) A few close relatives and friends—including an aunt, a cousin, and poet Arthur Hugh Clough, whom she was accused of working to death—devoted themselves to her causes and her campaigns, which in her last four decades of life she largely directed from her bed.

But Nightingale should also be seen as one of us moderns. Nothing is more striking than her contempt for the weight of tradition and authority, her demand that we modernize our lives and transform the social world at its roots. To be serious about nursing is to consider all the circumstances that keep us from flourishing, to preserve the health of families and cities, as well as the health of the body. The goal of nursing is to heal the world. Above this grand mission stands God, but a god of her own compounding. His laws are the laws of science, and we can only serve his purposes by working, working, working—struggling without rest for the visible publicgood. The call is to an endless labor that we must perform on our own with nothing to sustain us but the rousing of our own conviction. The exhaustion that Nightingale felt, and that her biography stirs in us, is the modern exhaustion of the fully self-assigned life.

It’s such a story, this life, and it comes in three oddly shaped acts. For a long time, much too long, Nightingale struggled against her family: its upper-middle-class complacency, its conventionality. Music, needlework, drawing-room chatter, the management of servants—these were the tasks for unmarried daughters. And in the 1840s, just when the young Florence fixed on nursing as her vocation, it was a deeply despised form of labor, recently made grotesque (though hilarious) in the person of Dickens’ Sairey Gamp (Martin Chuzzlewit, 1844): the illiterate, inebriated fantasist, the prattling night thief with an imaginary friend. The genteel Nightingales could hardly imagine, and certainly could not abide, their respectable daughter stepping down the rungs of class to take up the mantle of nursing. Florence could imagine almost nothing else. The first long chapter in her life is a story of demand and resistance, Florence intent to become a nurse and her family, especially her sister (Parthenope) and mother (Fanny), refusing to unbend. They discouraged her from visiting hospitals; they prohibited her training; they called her back to the drawing room. But she was unsubdued and unreconciled. The struggle continued for years, until it became clear that the misery of the family would only worsen if Florence were not somehow accommodated.

Chapter 2 then appears in a flash. In the spring of 1853, she at last began work in London as superintendent in an institution tending “elderly gentlewomen.” By the fall of 1854 she was in Turkey, leading a team of nurses at the war hospital at Scutari. In February 1855, the Illustrated London News portrayed her as the lady with a lamp, and by the end of the year her fame was an avalanche, a torrent, an inundation. But then, soon after her return from the war in 1856—when her “saintliness” was an antidote to the embarrassment of an ill-managed war and when her reputation was rivaling the queen’s—the third chapter began. Nightingale refused the apparatus of fame. She kept her distance from the family, which now exulted in her success. (“They like my glory. … Is there anything else they like in me?”) Physical collapse overcame her; she surrendered interest in her own practice of nursing; she retreated to the Burlington Hotel, and there, as at various other addresses, she lived mainly as an invalid for the rest of her long life.

Bostridge’s account is such a good one because it breaks the grip of simplicity. Why did we ever want to keep Nightingale in a box? Why was it so important to make her saintly? And why did it feel amusing to call her a hypocrite? There were all those early idolaters, those mid-Victorians who named their children “Florence,” who subscribed to the Nightingale Fund, who wrote letters to thank her and poems to celebrate her, and who made her an icon of all that was selfless in womanhood. Then there were the mockers and insinuators of later decades, Lytton Strachey above all, who in Eminent Victorians saw her as twisted into the shape of her obsessions. But thanks to Bostridge—to his unbroken nontendentious curiosity—we can have a Nightingale of our own, a mixed life, too complicated for veneration or satire.

The most memorable and indigestible thing about Florence Nightingale is finally the ferocity of her self-determination. (“No one has ever done anything great or useful by listening to the voices from without”—”I can bray so loud.”) No will could be more concentrated or vehement or relentless. There in the service of others—always writing and working for the public good—she never broke free from self-assertion and self-righteousness, but also never from a clawing self-laceration. Her deepest motives? Do you really want to know them? Will we be any clearer—about Nightingale or our own call to service—if we settle questions of her desire, her ambition, her charity, her cruelty, her energy? Precisely by not settling such questions, Bostridge has told the story well, so well that we know we’ll never be finished with Nightingale, not even when all the Dude Ranch Nurses have gone home to mama.